Article Archive
November/December 2022

From the Editor: Taking Care
By Kate Jackson
Today’s Geriatric Medicine
Vol. 15 No. 6 P. 3

Trans and gender nonconforming individuals have, at best, been ignored by the health care industry and, at worst, been subject to discrimination. They often face barriers to adequate health care, such as transphobia and the lack of knowledgeable and culturally competent providers. The picture is worse for older adults and still worse for people of color.

Older trans and gender nonconforming people may fear denial of care, abuse, and the refusal of health care providers to affirm their gender identities. And some necessary care may not be covered by insurance. Bias and discrimination may keep individuals from reaching out for much-needed care. Further, those who may need long term or other institutional care may be afraid to seek it due to concerns about a potential loss of privacy.

This reluctance to reach out for care can have severe consequences for these individuals as their health needs go unaddressed and their conditions untreated. A recent article in Thomson Reuters Foundation News reveals that roughly 1 in 200 US residents aged 65 and older identify as trans. And the National Center for Transgender Equality noted in a 2012 report that “Transgender people report higher rates of disability, general poor health, depression, anxiety, loneliness, and suicidal ideation. Thus, many transgender elders enter their later years with severe health concerns yet without the social and community support to manage their health.” It seems little has changed.

According to “Improving the Lives of Transgender Older Adults: Recommendations for Policy and Practice,” released in 2012, data from the National Transgender Discrimination Survey indicate not only that 70% of transgender people older than 65 deferred transitioning because they feared employment discrimination but also that 13% responded to mistreatment by abusing alcohol and drugs and that 16% have at least once attempted to take their own lives.

Primary care providers as well as nurses, social workers, and others who care for geriatric patients must commit to providing gender-affirming care, being better informed about the needs of trans individuals and better prepared to offer culturally competent care, and increasing awareness of the laws that exist to protect their aging transgender patients from discrimination.

This issue’s Last Word column focuses on the need for this commitment. Kellan Baker, executive director of the Whitman-Walker Institute, discusses the important ways health care providers can support transgender elders and help them access appropriate care.

— Kate Jackson